Diabetes Mellitus Flashcards
1
Q
Diabetes Definition:
A
body is unable to produce or use insulin
2
Q
What are acute complications of DM?
A
- Diabetic Ketoacidosis (DM type 1)
- Hyperglycemic Hyperosmolar Nonketotic Syndrome (DM type 2)
3
Q
What are the chronic complications of DM?
A
- neuropathy
- nephropathy
- retinopathy
- gastroparesis
- CVD
- PVD
4
Q
What are risk factors for DM type 1?
A
- caucasion
- family hx
- genetic predisposition
- african americans have lowest incidence of this type in the US
5
Q
What is C-peptide and why do we test for levels?
A
- a substance released from the pancreas along with insulin in equal amnts
- used to differentiate DM type 1 and type 2
6
Q
What will the C-peptide levels be in DM type 1?
A
absent (0) or low (< 0.5 ng/mL)
7
Q
What acute complication(s) occur with DM I type?
A
diabetic ketoacidosis (DKA)
8
Q
Definition of DM type 1?
A
pancreas produces little to no insulin
9
Q
Islet cell antibodies and/or glutamic acid decarboxylase antibodies are found in which type of DM?
A
DM type 1
10
Q
What is the most prevalent type of diabetes mellitus?
A
Type 2
11
Q
what are chronic complications of diabetes mellitus?
A
- neuropathy (Peripheral and autonomic)
- nephropathy (May lead to end stage renal disease)
- retinopathy
- CVD
- PVD
12
Q
Notes: diabetes related retinopathy
- occurs in approximately 15% of patients diagnosed with diabetes after 15 years
- risk of occurrence increases by 1% each year after diagnosis
A
Notes: cardiovascular disease
- Diabetes is a risk factor for atherosclerotic development
- hypertension in diabetics type 2 is x2 greater than general population
13
Q
Islet cell antibodies and/or glutamic acid decarboxylase antibodies are found in which type of DM?
A
DM1
14
Q
What is the most prevalent type of diabetes mellitus?
A
DM type 2
15
Q
At what age does type one diabetes usually occur?
A
< 20
16
Q
At what age does type 2 diabetes usually occur?
A
> 45
17
Q
Definition of diabetes type 2?
A
Insulin insensitivity, resistance and/or impaired production of insulin
18
Q
What will the C peptide levels be in DM type 2?
A
normal or high
19
Q
In which type of diabetes mellitus will autoimmune antibodies be present?
A
DM type 1
20
Q
Metabolic syndrome is associated with which type of diabetes mellitus?
A
Type 2
21
Q
Metabolic syndrome by?
A
- Obesity: waist circumference
- > 40 inches for men
- ≥ 35 inches for women
- Hypertension
- abnormal HDL:
- men: < 40 mg/dL
- women: < 50 mg/dL
- abnormal triglycerides: ≥ 150 mg/dL
- fasting blood glucose: ≥ 100 mg/dL
22
Q
Ketone productions are seen in which type of diabetes mellitus?
A
Type 1
23
Q
What acute complication occurs with type 2 diabetes mellitus?
A
-Hyper glycemic hyperosmolar nonketotic syndrome
24
Q
Types of diabetes mellitus?
A
- type 1
- type 2
- gestational diabetes
- secondary diabetes r/t other primary condition
- pre-diabetes
25
Causes of secondary diabetes mellitus?
- hormonal excess
- medications
- pancreatic disease
- other genetic factors
26
Secondary diabetes mellitus occurs with which endocrine diseases?
- Cushing syndrome
- acromegaly
- hyperthyroidism
- pheochromocytoma
27
Which medications can cause secondary diabetes mellitus?
- Glucocorticoids
- diuretics
- phenytoin (dilantin)
- oral contraceptives
- Statin
28
Which pancreatic diseases can cause secondary diabetes mellitus?
- pancreatitis
- pancreatectomy
- cystic fibrosis
29
What genetic syndromes are associated with diabetes mellitus?
- Down syndrome
- Turner syndrome
- klinefelter syndrome
- wolfram syndrome
30
What does the acronym DIDMOAD stand for in Wolframs syndrome?
- diabetes insipidus (DI)
- diabetes mellitus (DM
- optic atrophy (OA)
- deafness (D)
31
What are the symptoms of type one diabetes?
- Polyuria, polydipsia, polyphasia
- rapid weight loss
- weakness/fatigue
- blurred vision
- nocturnal enuresis
- frequent infections
- changes in LOC (irritability to coma)
32
What body type is seen in patients with type one diabetes?
Thin, loss of subq fat and muscle wasting
33
What are the symptoms of type 2 diabetes?
- Maybe asymptomatic
- polyurea, polydipsia
- weight loss (yet patient is often overweight )
- weakness/fatigue
- frequent infections
- peripheral neuropathy
34
What body type is seen in patients with type 2 diabetes?
Obese or history of obesity
35
What positive findings need to be present on different days for diagnosis of diabetes mellitus and/or impaired glucose homeostasis?
- Symptoms of diabetes (polyurea, polydipsia, unexplained weight loss)
- random blood glucose ≥ 200 mg/dL
- Fasting blood glucose ≥ 126 md/dL on two separate occasions
- 2 hour post oral glucose tolerance test with 75 gram glucose load ≥ 200 mg/dL
- HbA1c ≥ 6.5%
36
What HbA1c value is indicative of prediabetes?
5.7 - 6.4%
37
Which lab should you check when testing for diabetes or on a diabetic patient?
- blood glucose levels, HbA1c
- urinalysis (to monitor for glycosuria or ketonuria)
- BUN and creatinine (r/o dehydration)
38
Ketonuria will be present in which type of diabetes?
DM type 1
39
What is the normal HbA1c range?
5.5 - 6.4%
40
how often should HbA1c levels be checked in patients with uncontrolled glucose levels?
quarterly (q 3 months)
41
Once optimal glycemic control has been reached how often should HbA1c levels be checked?
every six months
42
Nutrition breakdown for patients living with diabetes:
- total carbohydrates = 55-60% total caloric intake
- fiber = 25 g/1000 calories
- fats = 25-35% total calories
- protein = 15-20% total calories
43
How often should diabetics eat (type 1 and 2)?
- type 1: scheduled three meals each day and three snacks
| - type 2: eat meals five hours apart with few or no snacks in between
44
Overuse of alcohol can cause what condition in diabetic patients?
Hypoglycemia
45
Exercise recommendations for diabetic patients?
- Exercise > 30 min, with warm up and cool down.
- ≥ 150 min mod-vigorous aerobic activity/wk
- Monitor for dehydration, encourage fluid intake
- inject insulin in body part not being exercised
- eat additional carbs prior to exercise
46
Why is foot care important for the diabetic patient?
Because of increased risk of infection due to peripheral neuropathy (ex. loss of sensation)
47
Foot care infection prevention techniques for the diabetic patient?
- Examine feet daily including bottoms of feet and in between the toes
- report any changes in skin condition of feet immediately to the provider
- have nails trimmed by experienced health care provider
- wash feet daily with lukewarm water mild soap, Pat dry, apply lotion
- use caution with footwear (might not know they are too tight)
48
What is the initial dose range of insulin for an type one diabetic?
0.4 -1.0 units /kg/day
49
How is the total daily dose of insulin administered for a type one diabetic?
- 50% administered as basal dose QHS
| - 50% administered as prandial dose
50
Lantus and Detemir are what types of insulin?
long acting insulin
51
Lispro, Aspart, Glulisine, Regular are what types of insulin?
Short acting insulin
52
Name the long acting insulin types?
Lantus and Detemir
53
Name the short acting insulin types?
- Lispro
- Aspart
- Glulisine
- Regular
54
What is the dosage for Lispro (Humalog)?
0.5 -1 unit/kg/day
55
What is the dosage for Aspart (Novolog) insulin?
0.2 - 0.6 units/kg
56
What is the dosage for Glulisine (Apidra) insulin?
0.5 – units/kg
57
How and when is Glulisine administered?
Subq 15 minutes prior or 20 minutes after starting a meal
58
What is the onset of action for regular insulin?
30-60 minutes
59
What is the onset of action for lispro (Humalog)?
15-30 min
60
what is the duration of lispro?
3-5 hrs
61
what is the duration of regular insulin?
5-8 hrs
62
What type of insulin is NPH?
Intermediate acting
63
what are the types of NPH?
Humulin N and Novolin N
64
What is the onset of action for NPH?
2-4 hrs
65
What is the duration of NPH?
12-15 hrs
66
What is the onset of action for Glargine (Lantus)?
1-2- hrs
67
what is the duration of Glargine (Lantus)?
Up to 24 hrs
68
Which types of insulins can be combined in the same syringe?
short and intermediate acting insulin
69
What is the drug of choice for treating type 2 diabetes?
Metformin
70
It is recommended to add a Glucagon-like peptide one receptor agonist to the treatment of which diabetic patient?
Diabetes type 2 with actual or high risk developing atherosclerotic CVD
71
Type 2 diabetics with actual or high risk of of developing atherosclerotic CVD would benefit from the addition of which medicine to their treatment regimen? Glucagon like peptide one receptor agonist (GLP-1RA)
Glucagon like peptide one receptor agonist (GLP-1RA)
72
Sodium glucose Co transporter two inhibitor is recommended for which diabetic patient?
type 2 diabetic with established kidney disease or heart failure
73
Type 2 diabetics with established kidney disease or heart failure would benefit from the addition of which drug to their treatment regimen?
sodium glucose Co transporter 2 in`hibitor (SGLT2i)
74
When should treatment of type 2 diabetes should be considered If what symptoms are present?
- ongoing weight loss
- symptoms of hyperglycemia
- A1C > 10%
- BG > 300 mg/dL
75
What is the prandial or meal time dose of insulin for a type 2 diabetic?
4 units per day or 10% of basal insulin dose
76
What patient in medication attributes need to be considered when developing a therapy for type 2 diabetics?
- initial A1C
- duration of diabetes (how long they've had it)
- obesity status
- risk of inducing hypoglycemia
- risk of weight gain
- risk reduction in heart, kidney, or liver disease
77
The AACE/ACE guidelines recommend what type of therapy for an initial A1C < 7.5%?
monotherapy
78
The AACE/ACE guidelines recommend what type of therapy for an initial A1C 7.5 ≤ 9.0%?
Dual therapy
79
The AACE/ACE guidelines recommend Monotherapy for what entry A1C value?
< 7.5%
80
The AACE/ACE guidelines recommend Dual therapy for what entry A1C value?
7.5 ≤ 9.0%
81
When is insulin recommended for type 2 diabetics?
Pt on two oral antihyperglycemic agents and A1C > 8% and/or longstanding type 2 diabetes and less likely to reach third A1C goal with a third oral agent
82
What is the initial insulin dosage for T2D?
0.2 - 0.3 unit/kg/day
83
Note:
- basil insulin analogs are preferred over NPH insulin because a single basil analogue dose provides a flat serum insulin concentration for 24 hours or longer.
Note:
When transitioning off of an insulin drip reduced the calculated TDD by 80%, do to 20% of protein binding to IV bags and tubing. Then give 50% as basil dose and 50% as pre prandial dose.
84
Sulfonylureas are indicated for the treatment of which type of diabetes?
type 2
85
Sulfonylureas provide what duration of coverage?
12 - 24 hours
86
Glipizide, Glyburide, Micronase, Glimepiride are what category of drugs?
Sulfonylureas
87
Biguanides are recommended for the treatment of which type of diabetes?
type 2
88
Metformin HCl is what category of drug?
Biguanide
89
Alpha-glucosidase inhibitors are recommended for the treatment of which type of diabetes?
type 2
90
Acarbose and Miglitol or what category of drug?
Alpha-glucosidase inhibitors
91
Metformin HCL (glucophage) provides what duration of action?
6 to 12 hours
92
Metformin extended release (glucophage XL) provides what duration of action?
24 hours
93
What is the starting dose of metformin? 500, 800, or 1000 mg
500, 800, or 1000 mg
94
What is the daily dosage for metformin HCl?
500 - 2550 mg 1-3/per
95
What is the starting dose for metformin extended release?
500 mg
96
What is the daily dosage for metformin extended release?
500 - 2000 mg QD with evening meal
97
How is the Somogyi effect diagnosed?
At 3AM Hypoglycemic, then hyperglycemic at 7AM
98
What is the treatment for Somogyi effect?
- reduce or mid bedtime dose of insulin
- administer long acting insulin in the AM
- consider switching from lantus to levemir which is shorter acting
99
What is the dawn phenomenon?
Decreased insulin sensitivity at night due to presence of growth hormone, Hypoglycemic at 7:00 AM
100
What is the treatment for the dawn phenomenon?
add or increase the bedtime dose of insulin
101
What are the ADA glucose level goals for the following nonpregnant, preprandial, and post prandial?
- A1C < 7%
- pre prandial glucose 80 - 130 mg/dL
- postprandial glucose < 180 mg/dL
102
When should insulin therapy be initiated in noncritical hospitalized patient?
Persistent BG ≥ 180 mg/dL
103
When is a BG goal of < 200 appropriate?
in patients with terminal illness, limited life expectancy, or at high risk for hypoglycemia
104
What action is taken for a non critical hospitalized patient previously on insulin therapy?
reuce outpatient insulin dose by 20 -25%
105
How often should BG levels be checked in patients who are eating and NPO In an acute hospital setting ?
- Eating: prior to meals
| - NPO: q4-6hrs
106
How do you calculate the total daily dose of insulin when transitioning off of an insulin drip?
- (avg insulin gtt rate x past 6 hrs) x 24 hours = TDD
- Reduce TDD by 20%
- administer remaining 80%
- 50% = basal and 50% preprandial
- if NPO (no tube feeds) give entire dose as basal dose
107
What are the signs and symptoms of hypoglycemia?
anxiety, behavioral changes, cognitive dysfunction, sweating, palpitations, hunger, paresthesia, tremors, seizures, and coma
108
Symptoms of DKA include?
Polyurea, polydipsia, N/v, weight loss, vision changes, HA, Abdominal pain, bloating, Constipation, weakness and fatigue, altered LOC, flushed dry skin, kussmaul respirations, fruity breath, tachycardia, hyperkalemia, hypertension, temperature variation
109
DKA patients without infection are hypothermic, normothermic, or hyperthermic?
Hypothermic
110
DKA patients with infection are hypothermic, normothermic, or hyperthermic?
Normal or hyperthermic
111
What is the Blood glucose levels in patient with DKA?
> 250
112
ABG values (ph, pCO2, and HCO3) and interpretation for DKA patient?
- PH usually < 7.3
- pCO2 < 40
- HCO2 < 15
- Metabolic acidosis
113
Why does hyperkalemia occur during DKA?
shifting of hydrogen ions enter cells to buffer acidosis
| Hydrogen ions are exchanged for potassium ions
114
What lab values will be hi in a patient with DKA?
ketone in urine, potassium, BUN, hematocrit, serum osmolality, anion gap, cholesterol, triglycerides, amylase
115
what is the normal anion gap?
7 - 17 mEq/L
116
Fluid management of the patient in DKA?
Fluid replacement with 0.9% NS at 1000 ml/hr (1-2hr or 15-20 ml/kg/hr)
250 ml/hr after improvement of dehydration
expect to order about 4-8 liters of fluid during the first 24 hours of treatment
117
0.45% NaCl is what type of solution?
Hypotonic
118
When is 0.45% NaCl solution used in the treatment of a DKA patient?
Once the patient is hemodynamically stable to promote intracellular hydration
119
When and why is D5W/0.45% NaCl used in the treatment of a DKA patient?
When BG falls to 250 to prevent cerebral edema caused by lowering glucose too quickly
120
Before starting insulin therapy , serum potassium should be at what level?
3.3 mEq/L
121
When should long acting insulin and weaning of insulin infusion be considered in the treatment of a DKA patient?
When BG is 250 and the anion gap closed
122
When is basal insulin administered when transitioning from IV insulin to subq?
2 - 4hrs prior to IV insulin being stopped
123
Hyperosmolar hyper glycemic non ketosis occurs in which type of diabetic patient?
Type 2
124
why does Hyperosmolar hyper glycemic nonketosis occur?
patient is able to produce enough insulin to prevent ketoacidosis, but not enough to prevent severe hyperglycemia , osmotic diuresis, and extracellular fluid depletion
125
Why does hyperglycemia cast changes in LOC and neurologic signs and symptoms?
Increased osmolality causes intracellular and cerebral dehydration
126
How are ketones produced?
Lack of insulin results in low glucose use prompting the use a fat (lipolysis) as an energy source. fat breakdown results in ketone production
127
Acetone ( fruity) breath is noted in which type of patient and why?
DKA patient due to ketones
128
signs and symptoms of hyperosmolar hyper glycemic non ketosis?
changes in LOC, lethargy, seizures, stupor, coma, signs of dehydration, polyurea, hypertension, tachycardia, shallow breathing
129
Blood glucose levels impatient in hyperosmolar hyper glycemic non ketosis?
> 600
130
Lab findings in patient with hyperosmolar hyper glycemic non ketosis?
```
Blood glucose > 600
elevated serum osmolarity
elevated BUN and creatinine
elevated sodium
pH > 7.3
Normal anion gap
C peptides may be present (indicative of insulin production)
```
131
Why are serum sodium levels high in a patient with HHNS?
kidneys try to conserve water by retaining Na
132
What are complications too much fluid replacement?
cardiac failure, cerebral edema, seizures
133
Which electrolytes are trended during HHNS treatment?
Na, K, HCO3, Cl, phosph
